MIGS: Minimally Invasive Glaucoma Surgery

Minimally invasive glaucoma surgery, or MIGS, lowers eye pressure through tiny incisions. Compared with traditional glaucoma surgery, recovery is usually faster and the risks are lower. MIGS can often be done at the same time as cataract surgery.

Dr. Philip Ngai is a fellowship trained glaucoma specialist who performs a wide range of MIGS procedures and teaches other surgeons about them. Learn more about how we diagnose and manage glaucoma on our glaucoma care page.

How MIGS works

Glaucoma damages the optic nerve, most often because fluid inside the eye does not drain well and pressure builds up. MIGS procedures improve the eye’s natural drainage or reduce how much fluid the eye makes. Options include:

• Tiny stents that open a channel into the eye’s natural drain
• Canal procedures that open and stretch the drainage canal around the eye
• Tissue removal procedures that remove a strip of the blocked drainage meshwork
• Drug delivery implants that slowly release glaucoma medicine inside the eye for months, which can reduce the need for daily drops

Dr. Ngai chooses the procedure based on your type and stage of glaucoma, your eye pressure goal and your other eye conditions.

Who is a candidate?

• Mild to moderate open angle glaucoma
• Glaucoma and a cataract that needs surgery
• Trouble using drops, side effects from drops or high drop costs
• Pressure that is not at goal on drops or laser

Advanced glaucoma sometimes needs traditional surgery such as a trabeculectomy or tube shunt, which Dr. Ngai also performs.

What to expect

MIGS is an outpatient procedure at a nearby surgery center, usually under light sedation with numbing drops. Most patients return to normal daily activities within a few days. You will use drops for a few weeks and see us for follow up visits to check your pressure.

Insurance coverage

MIGS is a medical treatment for glaucoma. Medicare and most insurance plans cover it when it is medically necessary, subject to your deductible and copay. See surgery costs and insurance for more.

Common questions

Will MIGS cure my glaucoma?

Glaucoma cannot be cured, but it can be controlled. MIGS lowers pressure to protect your optic nerve. You will still need regular glaucoma checkups, and some patients still need drops.

Can I stop my eye drops after MIGS?

Many patients use fewer drops after MIGS, and some stop completely. It depends on how much your pressure drops and what your target pressure is.

Is MIGS painful?

Most patients feel little or no pain during or after the procedure. Mild scratchiness for a few days is common.

Can MIGS be done with cataract surgery?

Yes. Many MIGS procedures are done during cataract surgery through the same small incision, so you treat both problems with one recovery.